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South Dakota rates for HCPCS 82642

Dihydrotestosterone (DHT)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$27.52 / $76.09 / $133.19
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.92 / $26.15 / $27.52
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$58.10 / $58.10 / $58.10
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.86 / $53.53 / $66.91
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$27.63 / $33.15 / $139.08
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.59 / $26.35 / $48.80
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$35.14 / $59.65 / $61.93
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.17 / $61.93 / $79.50
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.28 / $70.54 / $80.44
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.30 / $17.57 / $35.14
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.28 / $29.28 / $29.28